HomeMy WebLinkAboutMortgage_Hensley�
,"'^ STATEMENT OF MORTGAGE OR CONTRACT INDEBTEDNESS a T ip Year
. FOR DEDUCTION FROM ASSESSED VALUATION
State Form <3709 (R70117-08)
� y�� � Prasaibed bY �Miant d Loral CovemmaM Finarce '. M
INSTRUCTIONS: Fle Mark
To be filed in person or 6y mad witl� the CountyAWitor d the county where fAe poperty is bcated. `-�
Filiry Dates: 7J Real Properfy: Must t2e during the year for which the deduction is soughL �,ra� �
2) Mo6de / Marw7aclured Homes nd assessed es Real Property: Must file duriig tl�e hveNe (12J mpnlhs�N� (�UNTY���Ufiar
the dedudion is sought �+�65 O
See reverse sitle (ar additional insWctions antl qualifications
T � D'atri�l
���
��������
March 1. amattl yBar
Y �me on
��a, ��
MdTII i. MlBIM1 Yf
- 000. y6i-o a��
R o'7 a�Y�
iss unpaitl as d AlMgape / CanUaU indeqeEness un{sid as d Is Ihe appGCarq Ihe sde
data of applimtion legal or eqtiRable owneR
}�-�' ❑ Yes ❑ No
H owned �uith sortreone other ihan s0�se, i�GC�e rifh wtnrn
b Ne G��' m Cuetlian: Mmialy fusessed
❑RealPfopeAy �MnuallyAssessetl
Mohile Hortie (IC 61.7-�
Narne d mongagee v coraraU se9er C//�Y\,lJ ./ 'v—
� �
aedrass d�rurpapee or mJma senaz (mmbei and s�eet �. sato. ane z& cme)
Nare o( assiprrea or oiher wvrier a holder d mulpape
ACOress d assipnee (rwrt0a and sbeel. dA: sbla. ard LP wde)
Does a�plicant own popeNy in arry dher I H yes. whal
courny m InOiana7
❑ Ves ❑ No
06Autlion appmved in Cie amouM af:
F7�7
I / We cer4fy
owner / mn6
aEOress of
COUNIY AUDfTOR
�-I�,t�.SC�I� C(J"'N iv� 1
�7 �y'�
20 _ ZO _ 20 20 20 _ 20 _
n / �°'"'h Data (mmf4 daY. Y��)
N
penalty of perp�ry N Ihe above aM fwegoing infarmation is W e and correct and that the appGCant is a msiCent ot Ind"ara and
of fhe afo entaned property on date applicatio� is fiied.
, Dace (rmuh QaY.1T.a)
an�(�erandsboc4 ' sble.andZlPODde)
riL s> �RrN��rD�r sN y�6�o
Mdress d aulMrized person (niunAer and 5l2ro1, crty, s�fe. and LP cndc)